社区老年人不同衰弱状态下双重任务行走步态特征的研究

目的探讨社区老年人双重任务行走步态特征及其与不同衰弱状况的关系。方法方便抽取社区老年人191例,根据简易衰弱量表(FRAIL)评分将老年人分为衰弱组(16例)、衰弱前期组(111例)和非衰弱组(64例),采用用一般问卷调查表、简易精神状态检查量表和便携式步态分析仪收集老年人基本资料和直线17 m双重任务行走时的步态参数,比较不同衰弱状态的老年人双重任务行走时的步态差异。结果不同衰弱状态的老年人双重任务行走时的步速、步频、步长、跨步时间比较,差异有统计学意义(均P 0. 01);衰弱前期组步速、步长显著低于非衰弱组(均P 0. 05),衰弱组步速、步频、步长、跨步时间显著低于非衰弱组和衰弱前期组(均P 0. 05)。结论双重任务的行走测试检测出社区老年人的步态性能出现紊乱,衰弱可加重步态进一步恶化。     

双重任务训练对养老院老年人步态与平衡功能的影响

目的 探讨双重任务训练对养老院老年人步态与平衡改善的效果。 方法 将养老院30例老年人按照随机数字表法分为观察组与对照组各15人。对照组按常规进行回春医疗保健操训练，观察组在常规训练基础上开展双重任务训练。于干预前和干预6周后进行步态参数测试及平衡测试。 结果 干预后，观察组步速、步长、双重任务步长、起立行走试验用时和双重任务起立行走试验用时、平衡功能评分显著优于对照组（P＜0.05，P＜0.01），两组双重任务步速及ABC平衡信心评分差异无统计学意义（均P＞0.05）。 结论 双重任务训练可改善养老院老年人的步态及综合平衡能力，但对其害怕跌倒心理的改善作用不显著。     

老年2型糖尿病患者双重任务行走步态特征与衰弱的相关性分析

目的了解老年2型糖尿病患者衰弱的发生情况及衰弱状态与双重任务行走步态特征的关系。方法方便抽取老年2型糖尿病患者189例,采用Fried衰弱表型量表评估其衰弱情况,便携式步态分析仪采集双重任务行走状态下的步态参数。结果 189例老年2型糖尿病患者无衰弱、衰弱前期、衰弱分别为30.69%、51.32%、17.99%;与非衰弱患者比较,衰弱前期及衰弱患者步速减慢、步频及步长减少、跨步时间延长(均P0.05);步速、步频及步长与衰弱程度呈负相关,跨步时间与衰弱程度呈正相关(均P0.01)。结论老年2型糖尿病患者衰弱发生率较高,衰弱患者的步态性能恶化较衰弱前期及无衰弱者更加明显,应关注衰弱患者的步态参数,避免出现跌倒等更严重的结局。     

四方联动防跌护理在社区跌倒高危老年人中的应用

目的探讨专科护士-社区护士-个体-家庭四方联动防跌护理模式在社区跌倒高危老年人中的应用与效果。方法选取深圳市龙岗区的2个社区,随机分为观察组和对照组,从两个社区登记建档的跌倒高风险老年居民中分别随机抽选45名进行干预。观察组采用"专科护士-社区护士-个体-家庭"四方联动推进的综合干预方案。对照组接受社区防跌倒常规护理。于干预前及干预后12个月使用修订版社区老年人跌倒危险评估量表、步态和平衡测试量表对两组老年人进行评测,记录两组1年内跌倒发生例次。结果干预期间跌倒发生情况:观察组1人次,对照组6人次。观察组步态和平衡测试得分提高,跌倒危险评估表得分降低,与对照组比较,差异有统计学意义(均P0.01)。结论四方联动的综合干预方案应用于社区居家老年人,能有效降低老年人跌倒风险,提升其防跌能力,对预防社区老年人跌倒的发生有积极作用。     

骨偏心距对全髋关节置换术后步态的影响

目的探讨人工全髋关节置换术后股骨偏心距对行走过程中术侧下肢步态时间距离参数的影响。方法按入组标准对2000年1月—2005年12月于我院行单侧人工全髋关节置换术后患者29例58髋进行标准骨盆正位X线片检查,测量双侧股骨偏心距,计算股骨偏心距比（femoraloffsetratio,FOR）。行三维步态分析,采集步态时间距离参数。根据FOR分组并对双侧下肢的各项数据进行统计学分析。结果手术侧FOR小于对侧为A组,共10例,手术侧单腿站立相、踏步时间及跨距与对侧比较,差异有统计学意义（P〈0.05）;分别对双侧下肢的步频、步速、跨步时间、踏步距离及双腿支撑时间进行比较,差异无统计学意义（P〉0.05）;手术侧FOR大于对侧为B组,共19例,双侧下肢各项步态时间距离参数差异均无统计学意义（P〉0.05）。结论人工全髋关节置换术后术侧股骨偏心距不足对患者步态具有重要影响;人工全髋关节置换术中重建股骨偏心距有助于髋关节生物力学的恢复和术后步态的改善。     

便携式步态分析仪对高弓足步态初步分析

目的采用便携式步态分析仪(PMA)收集高弓足及正常受试者的步态数据,比较并初步分析高弓足患者的步态特点。方法前瞻性收集自2014-01—2014-09诊治的高弓足20例(高弓足组),同期收集正常受试者20例(正常组)。记录并比较2组PMA测量的13项基本参数。结果与正常组比较,高弓足组单腿支撑时间、双腿支撑时间、步态周期时间、肢体摆动时间、步幅持续时间明显延长,抬腿力量、蹬地力量、跖屈力量、步速、步频明显降低,差异均有统计学意义(P0.05)。2组摆动力量、步长和步幅差异无统计学意义(P0.05)。结论高弓足患者行走时,存在行走时间延长、跖屈和蹬地力量降低的特点;而PMA评估步态安全、便捷、准确。     

社区老年人照顾者害怕老年人跌倒现状及影响因素分析

目的 了解社区老年人照顾者害怕老年人跌倒现状及影响因素。 方法 采用一般资料调查问卷、单条目问题法“您是否害怕您的照顾对象发生跌倒?”、国际跌倒效能量表、焦虑自评量表对武汉市3个社区的196名老年人照顾者进行调查。 结果 73.98%社区老年人照顾者害怕老年人跌倒;照顾者跌倒效能量表得分为(40.04±10.56)分;照顾者性别、照顾时间、对老年人活动能力的评价、劝阻老年人外出活动状况、老年人过去1年跌倒次数对照顾者跌倒效能有显著影响（P＜0.05,P＜0.01）,照顾者跌倒效能与焦虑得分呈负相关（P＜0.01）。 结论 害怕老年人跌倒的现象普遍存在于社区老年人的照顾者人群中,这种心理不仅会导致对老年人的活动限制,还会使照顾者产生焦虑情绪。     

双重任务和步行速度对慢性踝关节不稳患者步态变异性的影响

目的探讨双重任务和步行速度对慢性踝关节不稳定(chronic ankle instability,CAI)患者步态变异性的影响。方法选取我院2015年1月至2016年9月间诊治的16例患者,均有慢性踝关节不稳定症状,同时招募了16例年龄、性别相匹配的健康人作为对照组,在跑步机上测量在自定步速行走、双重任务自定步速行走、快速行走和双重任务快速行走四种不同条件下的步频的变异系数(stride time variability,STV)和步长的变异系数(stride length variability,SLV)。结果在自定步速行走(无双重任务)下,CAI和对照组的STV差异无统计学意义(P=0.346)。在健康对照组中,与自定步速行走模式下的STV相比,健康对照组人群的双重任务自定步速行走、快速行走及双重任务快速行走模式下的STV都降低(P值分别为0.011、0.016和0.001)。在CAI组中,与自定步速行走模式下的STV进行比较,只有双重任务快速行走模式下的STV降低(P=0.008)。两组受试者在四种不同行走模式下的SLV差异均无统计学意义。结论 CAI和健康受试者在挑战性的行走条件下均减少了步幅时间的可变性,但变化模式不同。与健康受试者相比,CAI患者出现因更高程度的步态障碍(概念混乱,应是"行走条件")导致其步态模式的改变,表明CIA患者感觉系统的适应性较低。     

便携式步态分析仪量化评价全膝关节置换病人的步态特征

[目的]利用便携式步态分析仪了解患者膝关节置换前后的步态参数变化及特点,指导全膝关节置换术(total knee arthroplasty,TKA)后的康复治疗,进而得出适用于临床的评价方式。[方法]通过便携式步态分析仪对行单侧TKA的患者进行术前及术后3个月的步态分析,评估术后步态参数改善程度。[结果]患者手术侧肢体摆动时间、步幅持续时间、摆腿强度、蹬地强度、跖屈强度、步速、步频、步长、步幅及行走中活动度在行TKA后3个月有明显改善。[结论]1全膝关节置换患者术后3个月疼痛明显减轻,膝关节活动度增加,功能得到良好改善;2对于术后康复锻炼,除常规增加膝关节活动锻炼外,还应加强股四头肌的锻炼,以增强术后膝关节稳定性,改善功能;3便携式步态分析仪(portable motion analyzer,PMA)可以客观地记录全膝关节置换患者术前及术后的步态参数,对评价手术效果及指导功能康复具有一定的参考价值。     

社区老年人身体机能状态及跌倒的相关因素分析

目的明确导致老年人跌倒的相关因素,为预防社区老年人跌倒提供依据.方法通过问卷调查评估124名60～85岁社区老年人跌倒情况和跌倒危险因素,并测试其身体机能.结果跌倒发生率为30.6%,跌倒的受伤率为60.5%;70～85岁年龄段老年人比60～69岁者身体机能状况差,且女性更明显;男性身体机能指标与跌倒关系不明显,女性的握力与跌倒密切相关(P＜0.05);排泄问题、肢体麻木感、在家中经常被绊滑、近一年因病住院、怕跌倒而限制外出、不能结算日常开支及有差点跌倒的经历与社区老年人跌倒密切相关(P＜0.05,P＜0.01).结论跌倒严重威胁社区老年人的健康,其原因复杂,社区护士应采取综合措施予以预防.     

Stability and Energy Criteria in Healthy and Paraplegic Subject Gait

Abstract: The functional electrical stimulation (FES) assisted gait of paraplegic patients is inferior to that of healthy subjects. The difference can be observed in terms of speed, upright balance, biomechanical energy consumption, and generation of propulsion forces in the direction of walking. The biomechanical structure of paraplegic subjects is the same as that of normal ones; however, the mode of walking differs significantly because of the reduced number of activated muscles and primitive control. The healthy subject is utilizing a 2-point dynamically stable gait. The paraplegic patient is using 4-channel FES and utilizing a 4-point statically stable gait. We believe that the FES gait can be improved if converted into a semidynamically or dynamically stable gait. The gait is considered statically stable if the center of gravity (COG) projection on the ground (PCOG) is inside the supporting area. For a quadruped, this is only possible if it is utilizing a creeping crawl gait. In this paper, the relationship between PCOG and the supporting area are discussed as a criterion for dynamic stability assessment. Results are shown for 3 different modes of 2-point and 4-point gaits.     

The effects of robot assisted gait training on temporal-spatial characteristics of people with spinal cord injuries: A systematic review

Context: Robotic assisted gait training (RAGT) technology can be used as a rehabilitation tool or as an assistive device for spinal cord injured (SCI) individuals. Its impact on upright stepping characteristics of SCI individuals using treadmill or overground robotic exoskeleton systems has yet to be established.

Objective: To systematically review the literature and identify if overground or treadmill based RAGT use in SCI individuals elicited differences in temporal-spatial characteristics and functional outcome measures.

Methods: A systematic search of the literature investigating overground and treadmill RAGT in SCIs was undertaken excluding case-studies and case-series. Studies were included if the primary outcomes were temporal-spatial gait parameters. Study inclusion and methodological quality were assessed and determined independently by two reviewers. Methodological quality was assessed using a validated scoring system for randomized and non-randomized trials.

Results: Twelve studies met all inclusion criteria. Participant numbers ranged from 5-130 with injury levels from C2 to T12, American Spinal Injuries Association A-D. Three studies used overground RAGT systems and the remaining nine focused on treadmill based RAGT systems. Primary outcome measures were walking speed and walking distance. The use of treadmill or overground based RAGT did not result in an increase in walking speed beyond that of conventional gait training and no studies reviewed enabled a large enough improvement to facilitate community ambulation.

Conclusion: The use of RAGT in SCI individuals has the potential to benefit upright locomotion of SCI individuals. Its use should not replace other therapies but be incorporated into a multi-modality rehabilitation approach.     

Normal Gait of Young and Old Men and Women: Ground Reaction Force Measurement on a Treadmill

Forty normal persons had their gait tested using an instrumented treadmill. All were tested at the same speed of gait. The temporal factors of gait, the ataxia, and the external work of the gait were all calculated from the ground reaction forces. Ten women and ten men aged 20-29 years and ten women and ten men aged 60-69 were tested. The study demonstrated a constant pattern of gait independent of age and sex.     

Correlations Between Changes in Gait and in Clinical Status After Knee Arthroplasty

Twenty-six knee arthroplasties in 22 subjects were studied clinically and in a gait laboratory before and on one or more occasions after surgery. The purpose was to identify changes in gait characteristics and relate them to changes in the clinical situation of the patients.

The gait patterns of the patients changed following surgery mainly with respect to their time-distance characteristics; stride length, cadence, time of swing, and time of support. Positive correlations were noted between these gait changes and the patient's pain, his limp, and his walking distance. It is concluded that the information obtained in a sophisticated gait laboratory is of limited value to the surgeon in his clinical assessment.     

An algorithm to reduce allogenic red blood cell transfusions for major orthopedic surgery

In a previous prospective study, we confirmed that transfusion-related immunosuppression predisposes to postoperative infections, impairs the postoperative healing of wound and thereby prolongs hospitalization. This increases the well-known risks, such as transmission of infection or transfusion reactions, and has obliged us to revise our transfusion guidelines. We used a relational database containing information about 28,861 orthopedic surgery patients was used to determine when and how to improve these guidelines for transfusions. The survey showed the circumstances surrounding a high incidence of allogenic red cell infusions: failure to follow the guidelines, the preoperative use of nonselective NSAIDs, low preoperative Hb level, failure to retrieve blood, and high cut-off values for allogenic red cell transfusion. The first step was to determine the Hb level before giving red cell infusions and ensure compliance with predefined cut-off values. Subsequent measures included: use of COX 2-selective NSAIDs alone in the perioperative period; erythropoietin and iron therapy when the Hb level fell below 13 g/dL; use of cell salvage during and after surgery; administration of aprotinin to patients expected to have a high blood loss. The type of anesthesia had no blood-sparing effect. Although these steps can not be regarded as a new approach, we show that by following a strict rules with appropriate steps and in a concerted fashion, the use of allogenic red blood cells was reduced by 80%. Moreover, the amount of blood saved had other effects - e.g., the incidence of deep wound infections was reduced by 40%. The outcome is described in an algorithm summarizing the steps in a comprehensive perioperative diagram for giving blood.     

Should I Stay or Should I Go? A Prospective,Blinded Study Comparing the Diagnostic Capability of Dynamic and Stationary Pedobarography in Plantar Fasciitis

The aim of this study was to determine the diagnostic capability of a dynamic gait analysis insole and compare its ability to detect clinical correlations to a common stationary analysis tool. Twenty-five patients with chronic plantar fasciitis were included in this prospective, blinded, diagnostic study. Conventional, stationary gait analysis on a force plate on an even surface and continuous dynamic pedobarography on a standardized course consisting of different gait tasks were performed and correlated to the disease severity. Mean patient age was 53.6 (range 41 to 68) years, with a mean pain level of 6.1 (range 4 to 10) on the Visual Analogue Scale and a calcaneodynia score of 48.7 (range 33 to 66). Significant correlations were seen between several dynamic gait values and clinical scoring: cadence (r_s?=?0.56, p = .004), stance time (r_s?=–0.6, p = .002), center-of-pressure velocity (r_s?=?0.44, p = .046), and double support time (r_s?=?0.42, p = .042). No significant correlations were seen between any force plate gait analysis values and clinical scoring. In this study setting, dynamic gait analysis was able to identify clinically relevant correlations to plantar fasciitis disease severity that standard force plate measurements could not.     

Gait analysis in patients operated on for sacrococcygeal teratoma

Background

Long-term follow-up of sacrococcygeal teratoma (SCT) is well established; however, little is known about the effects of extensive surgery in the pelvic and perineal region, which involves disruption of muscles providing maximal support in normal walking.

Methods

Thirteen patients operated on at birth for SCT with extensive muscle dissection underwent gait studies with a Vicon 3-D motion analysis system with 6 cameras. Results were compared with 15 age-matched controls. Statistical analysis was performed with Mann-Whitney test; correlations were sought with Spearman’s correlation coefficient.

Results

All subjects were independent ambulators, and no statistically significant differences were seen in walking velocity and stride length. However, in all patients, toe-off occurred earlier (at 58% ± 1.82% of stride length) than controls (at 65.5% ± 0.52%; P < .05). On kinetics, all patients exhibited, on both limbs, a significant reduction of hip extensory moment (−0.11 ± 0.11 left; −0.16 ± 0.15 right v 1.19 ± 0.08 Newtonmeter/kg; P < .05) and of ankle dorsi/plantar moment (−0.07 ± 0.09 right; −0.08 ± 0.16 v −0.15 ± 0.05 Nm/kg, p < 0.05). Knee power was also significantly reduced (0.44 ± 0.55 right, 0.63 ± 0.45 left v 0.04 ± 0.05 W/kg), whereas ankle power was increased (3 ± 1.5 right; 2.8 ± 0.9 left v 1.97 ± 0.2 W/kg; P < .05). No statistically significant correlation was found between tumor size and either muscle power generation or flexory/extensory moments.

Conclusions

Patients operated on for SCT exhibit nearly normal gait patterns. However, this normal pattern is accompanied by abnormal kinetics of some ambulatory muscles, and the extent of these abnormalities appears to be independent of tumor size. A careful follow-up is warranted to verify if such modifications are stable or progress over the years, thereby impairing ambulatory potential or leading to early arthrosis.